community health services integration planning process...

Community Health Services Integration Planning Process

DRAFT Integrated Service Delivery Model for

Peterborough City and County

March 5, 2014 DRAFT Integrated Service Delivery Model

I. Overview

The Central East Local Health Integration Network is one of 14 Local Health Integration Networks (LHINs)

established by the Government of Ontario in 2006. LHINs are community-based organizations with the

responsibility to plan, co-ordinate, integrate and fund health care services at the local level. LHINs provide

funding for hospitals, long-term care homes, community care access centres, community support services,

community mental health and addictions services and community health centres.

This document outlines the process undertaken by six community-based health service providers to develop a DRAFT Integrated Service Delivery Model for LHIN-funded community health services delivered in Peterborough City and County. Organizations that are members of the Peterborough City and County Integration Planning Team include: • Community Care Peterborough (CCP) • Community Counselling & Resource Centre (CCRC) • Hospice Peterborough (HP) • Lovesick Lake Native Women’s Association (LLNWA) • St. John’s Retirement Homes Inc. (SJC) • Victorian Order of Nurses for Canada, Ontario (VON)

The process is now at the point of seeking broader input on whether the proposed DRAFT Integrated Service

Delivery Model will improve people’s experiences in accessing, receiving and/or delivering community-based

health services. Therefore this document is now being shared with the community - including clients and

caregivers, staff, volunteers, board members, community residents and other health care partners - in order

to seek their comments and ideas.

The feedback collected from the community will support the development of a FINAL model which will be

presented to each organization’s Board of Directors and the LHIN Board in May 2014.

II. Background

On February 22, 2012, the Central East LHIN Board of Directors approved a Community Health Services (CHS)

Integration Strategy to address demographic pressures, adjust to changing expectations of patients and

families and to meet provincial expectations on improving access, quality and value for money/investment.

The Strategic Aims for the Community Health Services (CHS) Integration Strategy are to:

improve client access to high-quality services,

create readiness (capacity) for future health system transformation and,

make the best use of the public’s investment

by designing and implementing a geographic-based service delivery model for Community Support Services

agencies by 2015 through the integration of front-line services, back office functions, leadership and/or

governance.





In launching the strategy, the LHIN identified a number of Group 1 Community Support Services agencies that

would be directed to participate in the facilitated integration process in each of the clusters. Group 1 agencies

included those single or multi-service health service providers (HSPs) who provided services within a clearly

defined region within the Central East LHIN (including LHIN services provided through municipalities.) The

integration planning began with this group, and other specifically identified agencies, based on the LHIN’s

determination that integration would most likely achieve the greatest return on investment.

Agencies that were categorized as Group 2 (HSPs with broader affiliations – cross LHIN, provincial, national)

and Group 3 (serving multiple LHIN clusters or a specific client population) were to be included in later phases

of the strategy although they could request to be included or be asked by the LHIN to join in the early timing.

The Central East Community Care Access Centre, which has a single governance structure for the Central East

region, was not included in the CHS Integration Strategy.

The process was initiated in the Durham Cluster in April 2012 and was planned to roll out as follows to the

other Clusters:

• Durham Cluster Start: April 2012 Finish: March 2014

• Scarborough Cluster Start: Nov 2012 Finish: Nov 2014

• Northeast Cluster Start: June 2013 Finish: March 2015

Adjustments to the CHS Integration Strategy phasing in the Scarborough and Northeast Clusters were required

to support the alignment with provincial priorities including Health Links and Small Rural and Northern

Transformation fund implementation in the Northumberland, City of Kawartha Lakes and Haliburton

communities. Therefore the Peterborough City and County Integration Planning Team (IPT) began their work

in August 2013.

III. Current State – Services and Access

As the process got underway, the IPT mapped out the current state of services and access to services (service

delivery). Currently the six organizations provide a wide variety of community support services from locations

across Peterborough City and County. Together these agencies spend over $8 million annually to deliver

services of which nearly 40% or $3 million is provided by the Central East LHIN. Other government funding,

including funding provided by municipal and regional governments, one-time grants, fundraising activities and

donations make up the funding difference.

Collectively, the six organizations involved in this facilitated integration serve the respective municipalities of

Trent Lakes, Selwyn, Asphodel-Norwood, Cavan Monaghan, Douro Dummer, Havelock-Belmont-Methuen,

North Kawartha and Otonabee-South Monaghan and the urban centre of the City of Peterborough. Together

with other LHIN-funded and non-LHIN funded community and health care partners, their focus is on providing

quality services to the residents of this part of the LHIN’s North East Cluster.





To access a visual overview of the services provided by the organizations involved in the Peterborough City

and County facilitated integration process, please click on the link below:

• Link to Peterborough City and County bubble diagram (See Appendix 1)

The diagram below illustrates how people currently access the LHIN-funded health services delivered by the

Peterborough City and County organizations involved in this facilitated integration.





IV. Creating a Directional Statement

As a next step in the process, Governors and management representing the six organizations met in October

and November 2013 for two facilitated Strategy Sessions to reinforce understanding of the Governors’ role in

the facilitated integration process, develop possible options to explore, determine success criteria to guide the

establishment and evaluation of integration options and to provide direction to the IPT to inform their next

steps.

This resulted in the creation of a Directional Statement that contained six possible integration options for the

IPT to explore as they began to develop a DRAFT Integrated Service Delivery Model.

The options included:

• Advisory Committee: Creation of an Advisory Committee to reflect the interests of all organizations

and funders. Advisory Committee would be a strategic and operational planning partnership and

strategic alliance between community-based providers.

• Back Office Integration: – Identification of Centres of Excellence/Lead Agencies to deliver Back office

functions (BOF) for two or more of the six agencies or a Consolidated Single Back Office Function (BOF)

• Overarching Anchor/Umbrella organization: A new single organization (Anchor Agency) to be

accountable to the LHIN for the delivery of all LHIN-funded community based health services that

would continue to be delivered by six separate organizations in Peterborough City and County

• Integration of Front-line Services (I.e. transfers of service): Identification of logical re-alignment of

front line services between six entities

• Two or more integrated service delivery entities: Explore logical options for voluntary

merger/amalgamation of governance, leadership, service delivery and back office functions amongst

the individual agencies.

• One integrated service delivery entity: Creation of a new single Community Support Services (CSS)

entity for Peterborough City-County that would assume accountability for the delivery of all services

currently delivered by the six organizations with a new Board of Governors.

After some additional review by the Boards of the six organizations and the Central East LHIN, it was

determined that the IPT should focus on the first five options as they moved forward with the development of

a DRAFT Integrated Service Delivery model that would be evaluated using a Decision Making Criteria

Framework that included quality, access, client experience, sustainability, risk assessment and costs. The

outcome of that work is referenced on the pages below.





V. Key Elements of the DRAFT Integrated Service Delivery Model

The proposed DRAFT Integrated Service Delivery Model confirms that the six

organizations participating in this Peterborough City and County facilitated integration

would continue to exist and that current services would continue to be provided to

existing clients in existing communities and facilities.

A. Peterborough City and County Community Support Services (CSS) Leadership Council

As part of this proposed DRAFT Integrated Service Delivery Model, a Peterborough City and County

Community Support Services (CSS) Leadership Council would be created, initially comprised of governance

and senior management representatives from the six organizations. Supported by a strong Terms of

Reference including a common vision, goal and objectives, this Leadership Council would provide a formalized

structure for ongoing collaboration and co-ordination between current and future community-based health

service organizations to improve client access through sustainable, cost effective service delivery. By

overseeing the implementation of integrations contained in this DRAFT Integrated Service Delivery Model, the

Leadership Council would be accountable for monitoring the achievement of the strategic aims of the CHS

Integration Strategy (improved access, building capacity and increasing value for money), while pursuing

further CHS system transformation.

Benefits include:

Provides an avenue for community-based health service providers to collaborate on shared priorities

and funding opportunities

Increases awareness and knowledge of the services available for shared clients/residents

Retains the identity of the individual organizations while increasing collective capacity/clout

Provides a shared mechanism to implement front line and/or back office integration opportunities

Would be partnered with the Peterborough Health Link to support the seamless transition of clients

between community/primary care to hospital/acute care and back to community/primary care, better

supporting people to live in their own homes and in their own communities.

Development of joint proposals to access funding from local, provincial or federal initiatives.

Through the leadership, commitment and oversight of the Peterborough City and County Community

Support Service (CSS) Leadership Council, the following integrations would also be implemented:

B. Front Line Services Integration and Support

B1. Supported Referral Co-ordinators (SRCs)

Supported Referral Co-ordinators are specially trained staff, who work with potential clients and their families

to ensure they have streamlined access to community support services provided by Community Care

Peterborough and other Community Cares located in Kawartha Lakes, Haliburton County and Northumberland

County. At present, Community Care Peterborough’s Supported Referral Coordinator is located at the Central





East CCAC’s Peterborough Branch and works in collaboration with CCAC staff on requests for service, client

assessment and provision of service. Through a partnership, the Supported Referral Co-ordinator role would

be expanded to potentially support referrals to all the IPT agencies involved in this facilitated integration.

Benefits include:

Potential to support increased referrals to all IPT agencies

Streamline connections and communications between CCAC and IPT agencies to support smoother

referrals/easier access for clients.

Consistent collection of standardized data about community-based health service referrals to support

strategic planning for future services

B2. Community Assessment

An initial partnership between VON and CCP Community Assessment would have the potential to support all

IPT agencies. Front line staff of agencies would be empowered with the knowledge and tools required to

consider the full range of CSS services for clients they are assessing/supporting.

Benefits include:

front line staff from VON and CCP would be better able to facilitate access for clients to a complete

basket of services

B3. PSW (Personal Support Workers) Education and Training

Personal Support Workers (PSWs) are integral to the delivery of a number of community-based health services

delivered by the organizations involved in this facilitated integration including Supportive Housing, Assisted

Living for High Risk Seniors, Home First, Home at Last, Adult Day Programs and other personal and home

support services. Through a partnership, Community Care Peterborough, VON and St. John’s Retirement

Homes would provide consistent education and training to the PSWs who work in their programs.

Benefits include:

Shared education and training would ensure all PSWs have development opportunities grounded in

best practice specific to their particular roles and scope of practice

B4. In-home Respite Services

Recognizing the need for additional respite services beyond what is currently being offered in Peterborough

City and County, CCP and VON would partner to explore the potential in expanding the respite services to

serve more clients.

Benefits include:

Caregivers receive the support and relief needed to allow them to support their family/friends to age

in place/remain at home.





B5. VON Seniors Maintaining Active Roles Together (SMART) Program /CCP Falls Prevention &

Exercise

A natural opportunity has emerged between VON and CCP to form a partnership to ensure appropriate

alignment between VON SMART Program and CCP Falls Prevention Program. This partnership would provide

the opportunity to ensure seamless and standardized care for clients requiring these services.

Benefits include:

Expanded access to the continuum (range) of exercise and falls prevention services ensuring right

care, right place, right time.

Provides a foundation for future coordination with the ongoing expansion of physiotherapy clinics

B6. Caregivers’ Integrated Support Services

Through a formal Memorandum of Understanding (MOU), CCRC and Hospice Peterborough would integrate

the delivery of their respective Caregivers’ Support Services.

Benefits include:

Provides the opportunity to jointly plan for service delivery

Enhances awareness of programs

Increases the number of referrals

Opportunity to share marketing and promotion resources

Enhance the quality of services by developing training capacity related to caregivers services

B7. Volunteer Support Services – Service Delivery

Through a formal Memorandum of Understanding, CCP and HP would integrate the delivery of their

respective Client Support Volunteer Services.

Benefits include:

Improves access to volunteers for the clients supported by CCP and HP

Improves the skill set of the volunteers

Improves the volunteer experience

Improves the quality of the client/volunteer interaction

B8. Aboriginal Cultural Awareness (LLNWA for all IPT)

LLNWA would further develop its role as a Centre of Excellence by expanding and developing cultural

awareness education opportunities through a partnership between LLNWA and the IPT agencies.

Benefits include:

Provision of aboriginal cultural training, awareness and appreciation across organizations

Enhancing the experience of aboriginal clients in all agencies





B9. Death, Dying and Grief Awareness

By expanding and developing awareness education opportunities in hospice palliative care, HP would further

develop its role as a Centre of Excellence, through a partnership between HP and the IPT agencies.

Benefits include:

Provision of hospice palliative care training and awareness across organizations

Enhancing the experience of families living with serious illness and grief served by all agencies

C. Back Office Services

C1. Intake and Assessment:

As the use of standardized assessment tools become increasingly common across the community-based health

sector, the six organizations involved in this facilitated integration would partner to ensure consistent use of

electronic screening and assessment tools for appropriate new clients accessing their services and for

supportive referral co-ordination. The organizations would also work together in ensuring that their

respective staff are effectively trained in the use of electronic intake and assessment tools and best practices.

Benefits include:

Increased client and staff awareness of the services provided by the six organizations

Increased referrals between partnering agencies

Fully leverage the common assessment tools being used by the organizations to decrease the

duplication of similar services or processes

Decreased client frustration in having to provide similar information to multiple providers

C2. Volunteer Support Services – Recruitment, Orientation and Training/Education

With all six organizations benefiting from the support of committed volunteers, a partnership approach would

be established for community-based health service volunteer recruitment, training and co-ordination. This

partnership would involve volunteers who contribute through governance and administrative roles and could

include shared governance training, co-ordinated volunteer recruitment drives and expanded opportunities

for volunteers who wish to donate their time to a variety of CHS initiatives.

Benefits include:

Consistency in the recruitment and training of volunteers





C3. Human Resources (HR) Support

As the organizations reviewed the current administrative structures of each of their organizations, it became

clear that they could benefit by partnering to respond to shared human resources challenges, specifically in

cross-training staff to support succession planning and increasing their ability to more easily fill knowledge

gaps on a temporary or longer term basis to support any staff leaves or illnesses. Other areas that would be

explored include obtaining legal advice, staff recruitment and training with the goal of creating common and

enhanced HR expertise across the HSPs. With very lean administrative structures, many of these

responsibilities fall on the Senior Management in each of the organizations and compete with day-to-day

operational responsibilities.

Benefits include:

Expands the collective capacity of the community-based health service providers that could be shared

across the organizations

C4. M-SAA Reporting Support

Community-based health service providers sign M-SAAs (Multi-Sectoral Service Accountability Agreements)

which contain a number of performance indicators, performance standards, performance targets and

performance corridors. Quarterly, all health service providers are required to report to the LHIN on how they

are performing from both a financial perspective and a service delivery perspective based on this signed

service accountability agreement. While this is a mandated requirement for each of the HSPs, many express

challenges keeping up with the changing reporting requirements. A partnership approach to M-SAA

reporting would be established.

Benefits include:

Organizations would benefit from shared M-SAA reporting training and individual organizations could

improve their reporting capacity to enhance their M-SAA reporting expertise.

C5. Information Technology (IT)

Each of the organizations use information technology to support their day-to-day business practices and

service delivery. At the present time, each organization is individually responsible for the purchase,

maintenance and staff training for these capital assets. Identified partners would come together to complete

a joint IT strategic plan to guide equipment and software purchases and training needs.

Benefits include:

Centralized support for joint learning and the implementation of IT best practices

Potential cost savings through bulk/joint purchasing





C6. Marketing and Communication

More and more people are turning to community-based health service providers to access services that will

allow them to remain in their own homes and their own communities. Clients and their caregivers are often

unsure of the services available to them. As partners, the six organizations involved in this facilitated

integration would implement joint marketing and communication strategies to raise awareness about current

and future services available to local residents.

Benefits include:

Increased community awareness and increased referrals to available services

Decreased duplication of individual marketing and communication efforts leading to efficiencies

Decreased client frustration in knowing what services are available

VI. Potential Savings for Reinvestment

Currently, the Integration Planning Team is evaluating the potential savings for reinvestment that could be

realized through the proposed DRAFT Model.

Base budget increases within the CSS sector are unlikely in future years, as investments of the LHIN and the

province will continue to be targeted to priority initiatives and to HSPs who are working in an integrated

manner to deliver the continuum of services to accommodate the needs of clients and their caregivers.

Many of the proposed integration opportunities in the DRAFT Integrated Service Delivery Model relate to the

delivery of back office supports or accountability for the delivery of some shared front line services. It is

initially assumed that these opportunities may not immediately result in significant savings given that the

organizations are already operating with minimal costs for service delivery and administration.

The IPT will continue to discuss how the implementation of the proposed DRAFT model could result in savings

to be re-invested to expand services, promote increased capacity/sustainability and improve the delivery of

local community-based support services priorities such as expanded respite services and referral coordination.

VII. Future State – Services and Access The diagram on page 3 showed how people currently access services.

The diagrams on pages 12 through 15 show how people would access services in the future, with the “door”

to LHIN-funded services continuing to be any of the six organizations involved in this integration. Through

more collaborative relationships, a broader knowledge base and strategic alignments with other health care

partners, including the members of the Peterborough Health Link, clients and caregivers would experience

more streamlined transitions as their needs change and they seek new or different community health services.





If approved, the proposed DRAFT Service Delivery Model would not immediately lead to a change in how local

residents would access the LHIN-funded health services currently delivered by the six organizations involved in

this integration initiative. Instead, the DRAFT Model creates the initial mechanism for ongoing collaboration

and co-ordination, the shared accountability for some front line service delivery and more efficient provision

of back-office services.

VIII. Conclusion The Integration Planning Team is confident that the proposed DRAFT Integrated Service Delivery Model meets

the Strategic Aim set out by the LHIN and will lead to improved client access to high-quality services, create

readiness for future health system transformation and make the best use of the public’s investment. The IPT is

now seeking input about the proposed DRAFT Integrated Service Delivery Model through a targeted

engagement process with other health and social service providers, front line staff, clients, caregivers,

volunteers, donors, other funders and broader engagement with local residents.

We look forward to hearing from our communities on the recommendations contained in this proposed

DRAFT Integrated Service Delivery Model and we will ensure the feedback received will be reflected in the

FINAL document.

The FINAL document will be presented to the IPT Boards (May 2014) and LHIN Board (June 2014).





Peterborough City and County Community Support Services Leadership Council





Front Line Service Delivery





Back Office Service Delivery


Community Care

Peterborough

Community

Counselling and

Resource Centre

Centre for Health

Communities

Lovesick Lake

Native Women’s

Association

Community

Support Services

Hospice

Peterborough

St. John’s

Retirement Homes

Inc.

Services

Housing Resource

Centre

Counselling Program

- Social Work

SMART

Transportation

Credit

Counselling

Children and Family

Program

Meals on Wheels Palliative Care

Program

- the bricks and mortar/ operation are funded by the City of Peterborough

Community Service

Order Program

360 degree NP Led

Clinic

Caregiver Support and Adult Bereavement Program

Diner’s Club

Home at Last

Long Term Care

Program

Supportive

Housing

Visiting Social

& Safety

Nursing Services

through CCAC and

private pay

Service Arrangement

(Home Help and Maint)

Social Wellness and

Awareness Program

(SWAP-C)

Assisted Living for High

Risk Seniors

Overnight

Respite

(Draft: Oct 17, 2013)

Other Funding

Source

LHIN Funding

(Full or Partial)

Victorian Order of

Nurses of Canada –

Ontario Branch

Counselling Program

- Caregiver’s Support

Community Action Program

for Children (CAPC)

Van Service

Aboriginal Prenatal Nutrition

Program (APNP) - the dining room and commercial areas are self-supported

- and the Anglican Diocese from time to time fund capital projects

The Palliative Pain and Symptom Management Consultation Service Interdisciplinary Palliative Care Education

Wellness

Program

Community

Education Program

Adult Day

Programs

In Home Respite

(PSW) Services

Info and

Referral

NP Clinic

Keene

Foot Care

Emergency

Response

Home First

Falls Prevention and

Exercise classes

Blood

Pressure

Foot Care

Clinic

Health and

Wellness

Drop-In and

Outreach

Intergenerational

Medical Loan

Cupboards & Registry

Other Counselling

Services

APPENDIX 1 Peterborough CHS Integration

Current State Services – Bubble Diagram

community health services integration planning process...

Documents